|CLINICAL ROUNDS WEBINAR:|
Beyond Paleo: Moving from a Paleo Diet to a Paleo Template with Chris Kresser, M.S., L.Ac.
Wednesday, December 4, 2013 – 9pm EDT (6pm PDT)
Over the last couple of years, as the popularity of the Paleo diet has expanded, a lot of controversy has emerged over exactly what a Paleo diet is. Part of the problem is that there are now a number of authors and bloggers that advocate what might generally be called a Paleo diet, but with slight variations in each case. This has unfortunately led to some confusion for people new to the “Paleo diet”.
In this webinar,
Insomnia is a sleep disorder that includes trouble falling asleep, staying asleep, or waking too early, which can result in daytime impairment. Insomnia is a common problem that often occurs along with other diseases or emotional states, thus many clinicians and researchers consider it a sign of a deeper underlying condition. It can also, however, exist without other medical or mental health issues, and in these cases it is termed primary insomnia. Insomnia affects up to 10% of the population, although my feeling is that it is much higher. Chronically, it can increase the risk of, and may lead to, a variety of emotional and somatic conditions such as increased mortality and depression.
The Causes Are Many
Causes of insomnia are varied and numerous, including issues such as hormone imbalances, sleep hygiene, mental and emotional disorders, and drug use (legal or otherwise), including alcohol and caffeine. And as mentioned in a previous two part blog on melatonin, as we age and certainly for those over 55, hormone synthesis across the board significantly declines. Melatonin, the chief neurohormone responsible for sleep induction, is another casualty, with its decreased production adversely affecting sleep quality and quantity. In the elderly, melatonin supplementation makes clinical sense and may be a first line of defense against insomnia in this population.
Growing up as a child, packets of Kool-Aid were as ubiquitous in my life as yesterday’s meatloaf and driving without seatbelts (I still marvel at my mother’s ability to drive with her knees while applying makeup in the rear view mirror). Packets of the brightly colored soft drinks were a nickel a pack and came unsweetened (before the invention of artificial sweeteners), with sugar having to be added at home. Those were the days, right?
While Kool-Aid surprisingly still exists today, the beverage industry, especially for kids, has absolutely exploded with every permutation of taste, color, bubbly or not, and caffeinated or not, under the sun available for indiscriminant consumption. It may be a minor miracle that my siblings and I came out of those years healthy with no one displaying signs of diabetes or metabolic syndrome. But there is a significant percentage of the population that is not so lucky. The current modern American diet, high in sugar and simple carbohydrates, is directly responsible for the skyrocketing epidemic of diabetes and obesity, with soft drinks playing a significant role.
Just recently, at one of my son’s open house nights at his intermediate school, the principal actually made it a point to discuss the potential hazards of high-sugared beverages and energy drinks and their possible adverse effects on our children. What was surprising is that these kinds of issues have now reached a saturation point both in our conscious and in the media. This has evolved to the point where they are now being expressed openly, without fear of someone being labeled as overreactive.
While we correlate the tsunami-like surge of pathogenic weight gain directly to the ingestion of snow shovel-sized amounts of sweeteners, there appear to be other health issues associated with chronic soft drink consumption that most of us may not be aware of.
For instance, a recent study found that teens who drink more than five cans of non-diet, carbonated soft drinks every week are significantly more likely to behave aggressively, including carrying a weapon and perpetrating violence against their peers and siblings.
These sugary drinks also appear to have a negative impact on pulmonary health. A new study revealed that a high level of soft drink consumption is associated with asthma and/or chronic obstructive pulmonary disease (COPD).
In part 1 of this blog, I introduced the concept of melatonin being much more than a sleep aid, which normally is this hormone’s primary therapeutic application as a supplement. The main focus in part 1 was melatonin’s utility in gastrointestinal health and its role as a potent antioxidant. In this next installment, we will look at melatonin’s potential role as an anti-aging compound and its impact on the immune system, including its possible role in cancer.
Research has demonstrated a distinct relationship between the neuroendocrine and immune systems. This is illustrated by the existence of a feedback loop in which the endogenous compounds produced by the neuroendocrine system act on the immune system while the immune system then responds to this “information,” communicating back to the neuroendrocrine system through this feedback loop. For instance, both systems produce common compounds like ACTH and acetylcholine, which reinforces this notion. Melatonin is part of this communication network.
Regarding cancer, it appears that melatonin displays both anti-cancer and cancer-protective properties through various mechanisms of action including its functions as an antioxidant, a cell signaling agent, a regulator of gene expression, and an immune stimulant, among others.
Melatonin secretion is impaired in patients suffering from breast cancer, endometrial cancer, prostate or colorectal cancer. Not surprisingly then, it follows that the increased incidence of breast and colorectal cancers seen in night shift workers and the elderly suggests a possible link between diminished secretion of melatonin and increased exposure to light during nighttime or perhaps, simply age-related disturbances in circadian rhythm which may be directly related to a reduced capacity to produce melatonin as we age.
Depressed melatonin production has also been shown to adversely affect the production of B lymphocytes, a variety of immunoglobulins, T cells, NK cells, neutrophils and macrophages. Repletion of melatonin has been shown to augment the production of these important immune cells, thus having an impact on both innate and acquired immunity. Melatonin performs this function through a variety of mechanisms including activation of immune receptors found on immune organs, associated tissues, and stem cells. Melatonin increases monocyte sensitivity to various cytokine stimulants as well.
Again, as we age, like most hormones, melatonin production declines, which may be one reason the elderly experience a significant deterioration in their immune response and ability to fight infections. Does this imply the necessity of regular, consistent melatonin supplementation in the elderly?
While biblically, the poor maligned apple was regarding as the forbidden fruit that led to the downfall of “man” and the origin of sin, there are a number of Jewish scholars that suggest that it was actually the pomegranate that was the fruit from The Tree of Knowledge. Indeed, while the apple has an illustrious cultural, symbolic and even religious history, the pomegranate does not take a back seat in those departments.
While mythology and archetypal symbology is a fascinating and blog-worthy subject, today’s blog entry, however, is about the healing power of the pomegranate, which in my opinion is one of nature’s great gifts. All portions of the fruit including the flowers, seeds, skin, juice and oil can be used for a variety of applications, with recent research focusing on pomegranate’s antioxidative, anti-carcinogenic, and anti-inflammatory properties. Like many therapeutically relevant medicinal plants, it is the polyphenol family contained in the pomegranate that holds the most promise. These active compounds include ellagic acid, ellagitannins (including punicalagins), punicic acid, flavonoids, anthocyanidins, and anthocyanins.
While pomegranate juice has become extremely popular in the retail market, its ideal daily consumption can be expensive. Therefore, supplementation of juice and fruit extracts can be a much more practical and convenient option. One study evaluated the effectiveness of delivery of actives between juice and extract and demonstrated that both were similar in providing levels of polyphenolic metabolites in both serum and urine, therefore suggesting that supplementation may be nutritionally and therapeutically more practical.
With the continued rise in rates of diabetes, discovering therapeutic tools that can positively impact fasting blood glucose and insulin sensitivity is central to a comprehensive treatment protocol. In animal models of diabetes, extracts of pomegranate flowers were shown to significantly reduce fasting blood glucose while also increasing the production of antioxidant enzymes as well as glutathione. This is a very important property as high levels of oxidative stress are inherent in diabetes, the consequences of which are highly damaging to various vulnerable tissues including those of the nerves, eyes and kidneys. In the same study another bonus of the extract was its positive impact on the blood lipid imbalances commonly associated with diabetes.
As shown in separate study of oxidative stress caused by diabetes, excess oxidation was shown to erode optimal central nervous system function including learning and memory. Again, pomegranate flower extract was shown to mitigate the learning and memory impairments caused by diabetes-generated reaction oxygen species.
Glucose uptake in the gastrointestinal tract is performed primarily by an active transport system that lies within the intestinal epithelial cells. Pomegranate consumption was additionally shown to inhibit expression of these transporters, demonstrating pomegranate’s ability to regulate glucose absorption and ultimately blood glucose homeostasis.
It’s been a busy, productive and rather amazing Fall. Lots to write about. In celebration of the gorgeous New England weather, I’ve been spending much time on my bike the last couple of months, and it feels great!
Riding on Ridgefield back roads. Nothing beats it.
I just returned from speaking at the Nutri Advanced conference in London where Drs. Jeff Bland, Andrea Girman and Joe Pizzorno also presented. It was a great conference—the largest yet. UK is embracing Functional Medicine. And London was also absolutely lovely the week I was there.
The Millennium bridge, crossing the Thames from St. Paul’s to the Tate Modern. With Dr. Andrea Girman. We just saw the play Light Princess- words and music by Tori Amos. Amazing!
As always, I was thrilled to hear Dr. Bland speak. A founding father of Functional Medicine (he coined the term), his words nourish intellectually and also spiritually. Listening to him feels like receiving transmission f
rom a Zen master who happens to have a PhD in nutritional biochemistry.
Jeff presented on epigenetics, that is, the way in which environment can shape our DNA expression and determine whether or not we get a particular disease.
So, just because you have the DNA associated with a particular disease doesn’t mean you’re getting the disease. This is such an empowering statement. I’ll say it again: Just because you have the DNA, doesn’t mean you’re getting the disease.
Jeff provided a potent example of this truth: The BRCA1 and BRCA2 mutations are very closely associated with breast and ovarian cancer. Indeed, if you have a BRCA mutation, your lifetime risk of developing breast cancer is greater than 80%. Recall that Angelina Jolie—who has the BRCA1 mutation--just had a double mastectomy to significantly reduce her risk of developing breast cancer.
In an interesting epidemiological and sociological shift, while illegal drug abuse has declined over the years, prescription medication abuse has actually increased significantly along with prescription drug overdose.
With increased internet access, easier availability from friends and relatives, poor disposal of expired or unused medications, inadequate supervision of responsibly prescribed medications (mostly concerning teen and adolescent medication abuse) and a misperception that prescription medications are somehow safer than illegal drugs, this trend may be understandable. There is a certain irony, however, that legally obtained prescription medications may actually be injuring more people than illegal drug use.
Let’s focus on teens for a moment. In another interesting statistic, while only 1 in 100 parents believe that their child has used “study drugs” (Ritalin, Adderall, Ephedrine…), according to recent surveys, 1 in 8 to 1 in 10 teens have actually used such drugs. Additionally, grandparents, with their cornucopia of prescription meds that are kept within easy access, can add to the potential of teen drug abuse as they are a particularly tempting target for young people.
Medication abuse, whether conscious or unintended, may not be the only problem. Prescribing certain medications to those over 65 years of age, for instance, can increase the risk of unintentional or undesirable drug effects. The incidence of this occurance happens to a whopping 1 out of 4 elderly patients.
Off-label medication use is the protocol of pharmaceutical drugs for an unapproved and untested indication or in an unapproved age group, dosage, or form of administration. While certainly not illegal or unethical – and indeed, doctors have the latitude to prescribe a drug for any reason they deem medically appropriate – off-label medication use is not an uncommon practice. This routine procedure, however, can significantly increase the incidence of preventable, serious adverse drug events. For instance, atypical antipsychotic medications, a group of tranquilizing drugs primarily used for schizophrenia and bipolar depression, are commonly used for off-label conditions such as agitation in dementia, anxiety, and obsessive-compulsive disorder. But their efficacy in off-label uses appears to be mixed at best while increasing the rates of adverse reaction and mortality. Additionally, this class of medication when used in children and adolescents increases by three fold the risk of developing diabetes as well as well as weight gain and blood lipid abnormalities.
While my eldest is still a couple years away from becoming a fully fledged teen, I’m personally girding myself for the accompanying awkwardness and the probing, uncomfortable questions and behavioral changes that can be part of the wonderful world of puberty. Ah yes puberty. A process all human beings go through, some more gracefully than others and one which will transform my boy from an innocent Lego® and book-obsessed child to a fuzzy, mustachioed and leather jacketed street-tough teen. (Boy, if all those episodes of “Happy Days” during my formative years have jaded my concept of teens, what has repeated viewings of “Sponge Bob” done to my children?)
Anyway, setting aside my discriminating and sophisticated tastes in television viewing, gaining insight into the social, psychological and emotional development of our children may enable us fellow parents to accompany our children through this exciting and at times overwhelming period in their lives with some additional empathy and wisdom.
Generally speaking, teenagers can be a highly self-conscious group acutely aware of what their peers think. New research finds that teen self-consciousness is linked with specific physiological and brain responses that seem to emerge and peak in adolescence. Researchers found that an area of the brain, specifically the medial prefrontal cortex, is involved in psychosocial evaluation and whose activity can be measured as a response to psychological arousal through social evaluation. For example, this area of the brain will become more activated in response to peer scrutiny. The response decreases over time as we enter into adulthood, indicating that this heightened sense of self-awareness – which may at times seem to border on narcissism – is actually quite normal both socially and neurologically.
A behavior that is classically associated with adolescence is impulsivity. Challenging situations, peer pressure and a desire to “stretch one’s wings” through experimental and at times risky behavior – be it drugs, alcohol or sex – can obviously lead to trouble. Constructive and thoughtful solutions can be implemented in a proactive way to minimize impulsivity. Activities like stress management, relaxation techniques such as yoga, and team-building, which sublimates emphasize on the ego (“There is no ‘I’ in team”), can prove to be quite helpful.
Cultivating healthy, cohesive relationships with one’s siblings also seems to encourage and enhance positive attitudes while increasing self-control and social competence.
Additionally, sisters may be particularly important in the sibling dynamic. A recent study revealed that sisters had an ability to shelter their siblings from depression and associated feelings of alienation and self-consciousness. Interestingly, it didn't matter what the age differential existed between the sister and her siblings.
Another intriguing facet of child-rearing that has been shown to solidify and balance what for this particular age group could be a tumultuous time period is an emphasis on spirituality. While religious practices for many families is an integral part of the family dynamic, it appears that spiritual development and not religious practices per say (attending church services for instance) may be more impactful on a child’s happiness. To make children happier, we may need to encourage them to develop a strong sense of personal worth, a more solid sense of their place in the world, and a perception that their lives have meaning and value, all while developing deep, quality relationships.
Sometimes, when admiring the small army of broccoli plants growing in our garden – standing at attention as if they’re guarding their patch of soil from various animal and insect marauders – they look to me like beings from another planet, what with their large green bushy head and slender torso. And in spite of the 41st President’s famous aversion of the vegetable, these plant aliens are one of the healthiest and most nutritious power foods available.
While broccoli was originally a native of the Asia Minor and the Mediterranean region, it wasn’t until the 20th century that it finally became popular in the US and even then, for the most part, broccoli consumption was limited to Italian immigrants living here.
The understanding of broccoli’s health benefits has brought about a significant interest in and subsequent research on the plant in recent years. The family of compounds that have really grabbed the imagination of scientists is called the glucosinolates. This group of substances, once consumed, will, with the assistance of an enzyme called myrosinase, convert to a new biologically active group of compounds called isothiocyanates. One of them, sulforaphane, is the primary member of this group and has received a significant amount of scientific attention.
Phase II detoxification
Perhaps the most clinically valuable role isothiocyanates, and specifically sulforaphane, play in the human body is their ability to stimulate phase II detoxification pathways in addition to cytochrome P450 enzymes. The P450 enzyme family acts, among other things, as catalysts for reactions involving the metabolism of many drugs, precancerous chemicals such as PCBs, and hormones including 17-beta estradiol. This mechanism of action, the activation of P450 enzymes, in addition to activating Nrf2, may perhaps be where sulforaphane displays its cancer-protective properties. Nrf2 is a transcription factor that, when activated, stimulates the body’s primary antioxidatve response pathway. This pathway is essential in reducing damage and protecting cells as well as DNA from toxin-generated reactive oxygen species, which can lay the groundwork for the genesis of cancer.
One property that many clinicians may not be aware of is sulforaphane’s ability to heal gastrointestinal mucosa damaged by H. pylori. H. pylori infections can generate a high amount of localized oxidative stress. This effect can be very damaging, greatly compromising the integrity of the GI tract’s epithelial lining. It is again sulforaphane’s antioxidative properties that act as tissue-protective agents, minimizing GI damage in those suffering with H. pylori. Additionally, broccoli sprouts high in sulforaphane were shown to help control and minimize H. pylori colonization as well.